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PubMedDate not supplied

First results with the Blom-Singer adjustable tracheostoma valve.

The Blom-Singer adjustable tracheostoma valve (ATV) is a new tracheostoma valve, introduced in 1992 to improve voice rehabilitation after total laryngectomy. Little research has been done to evaluate the benefits of this valve. Our study evaluates the advantages and disadvantages of using this device. Eighteen laryngectomized patients with a low-resistance Provox voice prosthesis received an ATV, using minimal selection criteria. The patients are evaluated according to a specific protocol. The effectiveness of the humidifilter, valve and fixation method and the benefits are evaluated. Approximately 66% of the 18 patients are still using the ATV. We report the differences between the current users and the dropout group. Patient factors are discussed that seem to have an impact on the effective use of the valve, such as age and mucus production. We consider the ATV to be a valuable device for fingerless speech in the laryngectomized patient.

Adult↗
PubMedDate not supplied

Limitations of the Blom-Singer technique for voice restoration.

The loss of voice following total laryngectomy is a severe blow to a patient's functional and psychological well-being. Since the first laryngectomy numerous attempts at voice restoration have been attempted with only limited success. The tracheoesophageal puncture with insertion of the Blom-Singer valve is a major development in neoglottic reconstruction. Initial reports on the use of this technique have been very encouraging. Our initial experience has not been entirely satisfactory. The difficulties encountered include: 1) inability to manage the prosthesis in the home setting; 2) anatomical problems; 3) inability to produce fluent speech. While it is our impression that this new technique is the simplest and most effective method of voice restoration, it is not appropriate for all laryngectomies. Great care should be exercised in patient selection, and this may eliminate many of the difficulties encountered.

Aged↗
PubMedDate not supplied

Primary vocal rehabilitation using the Blom-Singer and Panje voice prostheses.

Vocal rehabilitation by means of tracheoesophageal puncture and placement of either the Blom-Singer or Panje silicone prosthesis has become a standard method of speech production following total laryngectomy. The same technique has been employed primarily at the time of the laryngectomy by the Department of Otolaryngology-Head and Neck Surgery, Indiana University Medical Center, and our experience with 11 patients undergoing this technique forms the basis for this report. Of the ten patients available for evaluation, all have developed satisfactory prosthetic speech 2-12 weeks following total laryngectomy. Advantages of this technique include the utilization of standard laryngectomy without compromise of oncologic principles, elimination of a second procedure to place the tracheoesophageal puncture, elimination of the nasogastric tube, care in the pharyngeal closure to afford the maximum success of prosthetic speech production, and finally, the psychological boost. Limitations of the technique have been few but relate to limited voicing with postoperative radiotherapy and unrealistic patient expectations.

Aged↗
PubMedDate not supplied

Voice restoration of the total laryngectomy patient: the Singer-Blom technique.

In 1979 Singer and Blom described an endoscopic technique of vocal rehabilitation of the total laryngectomy patient. We have used this technique in 26 patients. Fluent speech developed in 24 patients. Four patients inadvertently had the devices used in this technique fall out of the fistula with subsequent closure. They will need repuncture. Two patients who had excellent speech voluntarily removed their devices. One transient case of aspiration responded to silver nitrate cautery of the fistula and placement of a new device. We believe that at the present time this is the surgical procedure of choice to vocally rehabilitate the total laryngectomy patient.

Catheterization↗
PubMed1988

An endostomal tracheostomy tube for leakproof retention of the Blom-Singer stomal valve.

Patients in whom fistula speech has developed after laryngectomy usually have to occlude their stoma with a finger to talk. This prevents the air that is needed to activate the fistula from being exhaled through the stoma. In order to free the hand, Blom and Singer devised a diaphragm-valved stomal device known as the tracheostoma valve. This device snaps into a flexible retention housing that must be carefully cemented to the skin. Some patients who have undergone near-total laryngectomy (and others with tracheo-esophageal voice prostheses) are unable to use their devices because the moisture and pressure around their stomas break the seal. Since air that is used to produce voice with the valve tends to lift the housing away from the stoma, a better housing design would assure that this motion would improve the seal.

Aged↗
PubMed1996

MRI as an aid to the fitting of tracheo-oesophageal Blom-Singer valves post-laryngectomy.

The Blom-Singer valve is a device for facilitating speech in patients who have undergone total laryngectomy. The valve is inserted into a surgically created tracheo-oesophageal fistula. Fitting the valve and determining the correct length and direction of the fistula, although usually straightforward, can be difficult. We describe two patients in whom MR imaging of the fistula tract has aided valve fitting.

Adult↗
PubMed1981

The Singer-Blom speech rehabilitation procedure.

Singer and Blom have recently reported a new surgical method for speech rehabilitation of the alaryngeal patient. The method consists of a tracheoesophageal, puncture (TEP) followed 2 to 3 days later by insertion of a silicone "duckbill" prosthesis which acts as a one-way valve allowing pulmonary air to enter and vibrate the esophagus but preventing aspiration. Along with more rapid acquisition of speech, the advantage of tracheoesophageal speech over esophageal speech is the greater volume of air flow through the vibrating segment of the esophagus, which allows smoother and more prolonged speech. Thirteen of our 18 patients (72%) who have undergone TEP are currently using tracheoesophageal speech. The complications associated with this procedure include the TEP tract closing, tracheal mucositis, stenosis of the tracheostoma, aspiration of the prosthesis, esophageal tear, and aspiration from the esophagus. Although we have encountered several problems, we enthusiastically endorse this procedure since it provides oral communication which is comparable to, and in many cases better than, that of the majority of esophageal speakers.

Esophagus↗
PubMed1993

Microbial colonization of Blom-Singer prostheses in postlaryngectomy patients.

The microbial colonization of 44 Blom-Singer valves obtained from 16 patients over an 11-month period was investigated both by standard microbial culture methods and scanning electron microscopy (SEM). The valves were all removed from the patients after failure to function correctly. The microbiology cultures revealed that Candida species and Staphylococcus aureus were present either individually or in combination on 43 valves. SEM showed yeast hyphae attached to and penetrating the surfaces of the 5 valves examined. Colonies of staphylococci were also seen on 2 of these 5 valves. Unlike similar investigations on other voice prostheses, S aureus colonization was associated with Candida colonization and valve failure.

Candida↗
PubMed2003

Voice restoration with low pressure blom singer voice prosthesis after total laryngectomy.

The main problem after total laryngectomy is permanent loss of voice. Current methods of vocal rehabilitation after total laryngectomy include development of esophageal speech, use of artificial larynx, tracheoesophageal shunt operations and more recently surgical restoration of the voice with prosthesis. Primary voice restoration using Blom- Singer voice prosthesis after total laryngectomy and pharyngeal myotomy was performed in 187 patients between October 1992 and July 2000. There were 184 male and 3 female patients of average age 63.7 years (range 42-76). Mean follow up period was 62 months. Satisfactory speech was achieved in 156 patients (83.5%). During the follow-up period, we experienced complaints of insufficient voice in 31 (16.5%) patients, due to partial spasm in 17 and total spasm in the pharyngoesophageal segment in 14. Furthermore, 24 (12.8%) patients preferred esophageal speech or electro larynx because of low socioeconomic level. The overall success rate was 70.7%. In this study the results of the surgical technique and prosthesis insertion, as well as the associated complications and socioeconomic levels of the patients, are discussed.

Adult↗
PubMed2002

[Vocal nodules in professional singers of classical style].

Whether physiologically correct singing promotes disappearance of vocal nodules (VN) was studied in 27 professional classic style singers having VN for 20 years. VN arose primarily in women, tended to recur. As shown by examination with laryngostroboscope, electroglottograph and sound level meter, physiologically correct singing resulted in temporary disappearance of soft nodules but hard nodules did not resolve. It is inferred that professional singing is not recommended for subjects with hard vocal nodules.

Adolescent↗
PubMed2003

Evaluation of a modified live virus type-1a bovine viral diarrhea virus vaccine (Singer strain) against a type-2 (strain 890) challenge.

Both type-1 and type-2 bovine viral diarrhea virus (BVDV) infections are responsible for major losses in the cattle industry. However, several commercial BVDV vaccines contain only a type-1 strain. A vaccine trial was conducted to evaluate the efficacy of BVDV type-1 (Singer strain; BVDV-1) vaccine for protecting calves challenged with virulent BVDV type-2 (890 strain; BVDV-2). Thirty-eight BVDV-negative calves were randomly allocated to four groups. One group was treated with a modified live virus (MLV) BVDV-1 vaccine by i.m. injection and another group was treated with the same vaccine by s.c. injection. Two groups served as nonvaccinated controls (one i.m. and one s.c.). Twenty-eight days following vaccination, the calves were challenged with BVDV-2 and monitored for 21 days. Clinical scores and body temperatures of vaccinated calves were significantly (P<.05) lower than for controls on several days, and peak differences occurred 8 days after challenge. The control calves had significantly (P<.05) lower leukocyte counts 3 through 8 days after challenge; leukocyte counts for vaccinated animals did not decline significantly from prechallenge levels. There were no differences in protection between the i.m. and s.c. routes of vaccination. The study demonstrated satisfactory cross protection of the BVDV-1 vaccine against BVDV-2 challenge.

Animals↗
PubMed1990

[Voice breaking in young singers].

The adolescent's phonatory apparatus undergoes profound modifications during the period of voice breaking: lowering and growth of the larynx, change of vocal type. Voice-breaking occurs in two phases with the singing voice being modified essentially during the second phase, with a time lapse in relation to the speaking voice. Although stopping singing appears to be a reasonable attitude, it can not always be obtained, and therefore, the young singer can be helped through this period of change by developing a vocal technique adapted to this period.

Adolescent↗
PubMed1985

[Speech rehabilitation following laryngectomy with the Blom-Singer prosthesis].

The Blom-Singer prosthesis was used on 18 male patients. 61% of these acquired fluent speech, 11% spoke partially and 28% were not able to use the prosthesis at all. Complications included dysphagia and difficulties with the function of the prosthesis. In some cases surgical revision or removal of the prosthesis was necessary. Older patients and those living in poor social conditions should not be selected for this procedure as their cooperation and motivation often seem to fail.

Adult↗
PubMed1985

Speech rehabilitation outcome after Blom-Singer tracheoesophageal puncture.

This study evaluated speech rehabilitation outcome and length of training needed for laryngectomized patients who underwent the Blom-Singer tracheoesophageal (TE) puncture procedure. Preoperative patient selection criteria included: 1) acceptable stoma size, 2) adequate motivation and manual dexterity, 3) absence of constrictor spasm. Training focused on coordination of breath control, articulation, muscle relaxation, and proper handling and maintenance of the "duckbill" prosthesis. Speech intelligibility in 12 patients was evaluated following the completion of their speech rehabilitation program, using the CID Everyday Sentences. Each patient was videotaped; the tape then was presented to unbiased listeners who recorded the sentences. The median percentage of intelligibility for the 12 patients was 89.5%; only one patient had a median score less than 60%. The mean length of formal training for the group was only 3.2 hours (range 1 to 7 hours). The percentage of patients attaining speech and the quality of their speech intelligibility was found to be higher than with esophageal speech, which is both time consuming and often difficult to learn. TE puncture followed by proper fitting and training in voice prosthesis usage improves speech rehabilitation outcome for the laryngectomized patient.

Adult↗
PubMed1982

[Examination of the correlation between lung function and voice quality after glottoplasty or Blom-Singer-puncture (author's transl)].

The correlation between lung function and the quality of oesophageal speech was investigated in 36 patients who had undergone laryngectomy with glottoplasty. It was found that this correlation did not depend on any important lung function parameters. Lung tests were carried out on 10 patients before and after laryngectomy. No changes in lung function could be found that may have been directly attributed to a laryngectomy. This means that restrictive or obstructive lung disturbances do not contra-indicate glottoplasty or a Blom-Singer-puncture.

Aged↗
PubMed1981

[Comparison of the Waaler-Rose reaction and the optimized Singer-Plotz reaction].

The latex reaction according to Singer & Plotz, an optimised version of the same employing heating at 56 degrees C for 24 hr, and the modified Rose-Waaler test were used to determine rheumatoid factor in the serum of 65 subjects, including 33 with rheumatic and joint diseases, 22 with liver diseases, and 10 presumed to be normal. This optimised latex test is put forward as a supplement to high sensitivity of the simple latex test, and the high specificity of the Rose-Waaler test. In the series examined, it gave results whose clinical comparability was at least on a par with that provided by the Rose-Waaler test.

Adult↗
PubMed1996

[Acoustic measurements, perceptive judgements and physiological correlates of the "singing-formant" in male and female opera singers].

At the crossroads of speech and music, this research contribute to a description of the "singing-formant" not only in its acoustic aspects, but also in its physiological and perceptive aspects. From systematic spectral analysis of the phenomenon, the singing-formant is firstly redefined and described from an acoustic point of view, as a reinforcement of extra energy at around 2800 Hz in male subjects and up to 4000 Hz in female ones. What is the perceptive significance of such a phenomenon? Taking into account the voicing context of lyrical singing, we then attempt to show the impact of the singing-formant on the sounds perceived through perception tests. Finally, we attempt to explain its characteristics from a physiological point of view. Vibratory phenomena initially favour the emergence of high-pitched harmonics, richer in the larynx spectra of those of our subjects who have the singing-formant. From a resonance point of view from the analysis of the contours of middle sagittal slices of Magnetic Resonance Imaging (MRI) of the French vowels [a], [i] and [o] spoken and sung by a professional bass singer, the area functions and spectra of sounds given out have been elaborated, thanks to the vocal tract acoustic simulation software of S. Maeda. Hypotheses relating to the nature and position of articulators favourable to the production of the singing-formant can then be given out, and are of great interest for the education and reeducation of the singing voice.

Acoustics↗
PubMed1984

Landmark article Oct 28, 1933. Successful removal of an entire lung for carcinoma of the bronchus. By Evarts A. Graham and J. J. Singer.

The left lung and many of the tracheobronchial mediastinal glands were removed in a one stage operation because of a carcinoma that originated in the bronchus of the upper lobe but which was so close to the bronchus of the lower lobe that, in order to remove it completely, it was necessary to remove the entire lung. This is apparently the first case in which an entire lung has been removed successfully at one stage. 600 South Kingshighway.

Carcinoma, Bronchogenic↗